Mr. Peter Tyndall:

I am very glad to have the opportunity to meet the committee today. The last time we met, some of the issues around nursing homes came up as part of the consideration of a wider report - the annual report - and I undertook to do some additional work for members to draw together some of the specific issues around nursing homes. I hope all members received copies of the general casebook and will continue to receive them post-GDPR. Within that, each particular area is dealt with under a separate heading but I thought it would be useful to pull together a nursing home casebook. We have hard copies here. I know members have all had an opportunity to see it online but we also have hard copies that we can leave with members should members want them.

We have tried to highlight some of the key areas of complaint that are dealt with by my office. Under the legislation as drafted, almost every nursing home is within jurisdiction. A complainant might not be in receipt of fair deal funding but if the nursing home is in receipt of fair deal funding, that brings it into jurisdiction. This means that virtually all of the 430 or so private nursing homes, as well as the public ones provided by the HSE, are now within jurisdiction.

Initially, take-up was slow, with only 57 complaints received in 2016. The end-of-year figure for last year, which supersedes the 79 outlined in the casebook, is 93, which is still lower than we would wish. Nonetheless, it gives us an opportunity to deal with issues. It is worth noting that if a resident at a nursing home complains about an issue that affects other residents in the home, any resolution will not only benefit the person who complains, it will also lead to changes for all residents such that while the number of complaints is low, the benefits are wider than would otherwise be the case.

Members will have seen the articles in the newspapers over the weekend regarding additional charges. The comment I made, which was repeated, was that people are being impoverished by the charges. I will give some examples. There were people left with almost no money. This meant that those who are keen on their appearance had no money to buy the make up they would ordinarily have bought. We heard of people being left with disposable incomes of €7 per week, of people having less to spend than their grandchildren in terms of pocket money and of people running up debts because they cannot afford the scale of the additional charges.

I have highlighted this issue previously . I am particularly concerned about security of tenure. The contract of care is a standard template. In essence, the nursing home does not have to provide any reason for terminating a contract of care. We have seen instances of people going into hospital and, on discharge, being refused re-entry to a home and of individuals being threatened with eviction because their families complain on their behalf. It appears that there is a major problem with the legislation and the contract. It is not acceptable that a person would have no certainty as to their capacity to remain within what has become their home. I have said previously that there is strong evidence to suggest that there are high levels of mortality following enforced moves for older people, particularly those with dementia. Not having security of tenure is not only a threat to their mental well-being, it is a threat to their physical well-being.

People in nursing homes should be able to access health professionals in the same way as anybody else in the community. The reality is that this is proving to be an issue for people complaining to my office. If the people who complain to my office are experiencing this problem, one must assume that those in other homes are experiencing it as well. In terms of advocacy, the threats to the capacity of somebody to remain in a home when people speak up on his or her behalf is one of the most serious issues that we face. There is no simple solution. Sometimes, family members can be unreasonable in the manner in which they deal with a home but it is this problem that needs to be dealt with and not the person's right of residence.

We welcome the increased expenditure available for supporting people in their own homes but the reality is we still have separate funding regimes. In terms of our hospitals and the problem of people waiting lengthy periods in emergency departments for beds, there are people in hospitals who have no need to be there. There must be a much more concerted effort to prevent people from becoming less able as a consequence of visits to hospital and to support them to become more able. This is very good practice. It is not that we cannot do it, only that we do not do enough of it. We then need to provide them with the supports they need in their own homes. Sometimes, the nursing home is the only option not because it is the best option - for some people it is a preference - but because the funding is not in place for an alternative. This remains one of the issues that concerns us in terms of our work.

We are planning to do some outreach work this year. There are 430 nursing homes and we cannot send staff to all of them. When we worked with people in direct provision, we found that there were individuals prepared to talk to staff who, in turn, might not be prepared to submit written reports. We intend to engage in some initial small-scale outreach to see if there are other issues that are not coming to our attention or if there are ways in which we could make ourselves more accessible.

I will be happy to answer any questions.